Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Tennessee for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Tennessee only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Tennessee (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Scott Sullivan (NPI 1689100471)

Field	Value
Entity Type	Individual
Organization	Scott Sullivan
Address	1432 Kimbrough Rd
City	Germantown
State	TN
ZIP	38138
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	May 11, 2017

Payer Source	Total Paid
Medicare	$3M
Medicaid	$0

Key Findings

Payer mix and scale: this provider reports $3M in lifetime Medicare revenue and has no Medicaid billing on file (none). The absence of Medicaid activity makes the practice effectively single‑payer (Medicare) at the dataset level, concentrating reimbursement exposure to Medicare policy and price changes.

Revenue concentration: the precomputed top 3 Medicare codes account for 87.1% of the provider's Medicare revenue. Those top codes are J2777 ($1.5M, 49.9% of Medicare revenue), J0178 ($998.9K, 32.4%), and 67028 ($149.3K, 4.8%), indicating a heavily concentrated revenue profile driven by a very small number of services.

Service-line implications: the claim mix is characteristic of a retina specialty focused on intravitreal pharmacologic therapy and retinal diagnostics rather than high-volume anterior segment surgery. High-volume biologic/drug codes J2777 and J0178 dominate revenue, while diagnostic imaging such as 92134 (1.1K claims, $30.7K revenue, 1.0%) supports a care model centered on medical retina visits and imaging-guided injection decisions.

National competitive standing on J2777: the provider ranks #95 of 2039 for J2777 (95th percentile) and is labeled notably above typical national volume for this code. Given J2777 represents $1.5M and 49.9% of Medicare revenue, the provider is a prominent national participant for faricimab intravitreal injections.

Competitive posture for J0178 and 67028: J0178 ranks #833 of 3204 (74th percentile; typical, unremarkable volume) while 67028 ranks #610 of 4255 (86th percentile; typical, unremarkable volume). These rankings indicate solid, above‑average utilization for aflibercept and vitreous injections relative to peers, but not the same level of outlier prominence seen for J2777.

Statistical outliers and billing patterns: several entries show atypical unit economics or rank profiles that merit attention. J3490 appears as 56 claims with $99K revenue ($1768 avg paid/claim) and ranks #1448 of 2838 (48th percentile), suggesting occasional high‑paid unclassified drug billing; J2403 shows 90.4K claims with $90.4K revenue ($1 avg paid/claim) and ranks #40 of 76 (48th percentile), highlighting an unusually large claim count paired with very low average payment per claim.

Tenure and enrollment: NPI enumeration date is 2017-05-11 (~9 years ago), indicating an established billing presence in Medicare over multiple years. This tenure supports the observed accumulation of $3M Medicare revenue and the development of high-volume drug administration workflows.

Business risk and opportunity: the practice is highly dependent on high-cost intravitreal drugs—J2777 (49.9%) and J0178 (32.4%) are the dominant revenue drivers—and simultaneously lacks Medicaid diversification (none). That concentration creates both operational scale advantages in administering injectable therapies and vulnerability to formulary changes, drug pricing shifts, or utilization-management policies affecting these specific agents.

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

23 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J2777	Injection, faricimab‑svoa, 0.1 mg	52,980	$30	$1.5M
J0178	Injection, aflibercept, 1 mg	1,480	$670	$998.9K
67028	The provider injects a medication into the vitreous chamber of the eye as an isolated procedure or a separate procedure unrelated to any other procedure being performed on the eye.	1,680	$90	$149.3K
J3490	Unclassified drugs	60	$1,770	$99K
J2403	Chloroprocaine hcl ophthalmic, 3% gel, 1 mg	90,400	$1	$90.4K
J2781	Injection, pegcetacoplan, intravitreal, 1 mg	510	$120	$61.2K
92134	The provider performs computerized diagnostic imaging of the retina in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both eyes.	1,060	$30	$30.7K
J2778	Injection, ranibizumab, 0.1 mg	180	$160	$30K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	400	$60	$25.1K
J7999	Compounded drug, not otherwise classified	170	$70	$11.4K

Showing 1–10 of 23

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 23 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Tennessee Distribution

Scott Sullivan — 0 of 23 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. state median

23 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	25	80	790	$680	$769.8K
J2777	4	50	15,060	$30	$592.1K
J2778	42	40	1,340	$180	$370.2K
67028	24	80	1,130	$90	$98.5K
J2781	12	20	560	$120	$82.5K
J2403	4	10	112,000	$1	$67.3K
J3490	38	60	70	$400	$41.9K
67042	12	40	20	$1,020	$34.5K
67108	7	30	20	$970	$29.2K
67036	12	20	20	$940	$24.4K

Showing 1–10 of 23

Related Providers

Other providers that share a Tax Identification Number (TIN) with Scott Sullivan, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Jackson Madison County General Hospital	TN	General Acute Care Hospital	$0	$46.6M
St Bernards Hospital Inc	AR	General Acute Care Hospital	$0	$35.4M
Jackson-madison County General Hospital	TN	Land Ambulance	$5.1M	$13M
West Tennessee Medical Group Inc	TN	Internal Medicine Physician	$0	$8.2M
Jackson-madison County General Hospital	TN	Community/Retail Pharmacy	$0	$7.4M
St Bernards Hospital Inc.	AR	General Acute Care Hospital	$0	$7.3M
Stephen Huddleston	TN	Retina Specialist (Ophthalmology) Physician	$5.7M	$0
Wt Medical Associates	TN	Rural Health Clinic/Center	$0	$5.5M
Wt Medical Associates	TN	Internal Medicine Physician	$0	$4.9M
Philip Ames	FL	Ophthalmology Physician	$3.5M	$350

Nearby Providers

Other providers in the same ZIP code as Scott Sullivan, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Byram Healthcare Centers, Inc.	TN	Durable Medical Equipment & Medical Supplies	$0	$44.3M
Campbell Clinic, PC	TN	Orthopaedic Surgery Physician	$0	$28M
The West Clinic P.C.	TN	Specialist	$0	$16M
Poplar Avenue Clinic PLLC	TN	Gynecologic Oncology Physician	$0	$9.7M
Diagnostic Ultrasound Consultants	TN	Diagnostic Radiology Physician	$0	$8.5M
Mid-south Imaging & Therapeutics, P.A.	TN	Diagnostic Radiology Physician	$0	$8.2M
David Portnoy	TN	Hematology & Oncology Physician	$6.5M	$0
Stern Cardiovascular Foundation, Inc	TN	Cardiovascular Disease Physician	$0	$4.7M
G I Diagnostic And Therapeutic Center LLC	TN	Endoscopy Clinic/Center	$4.2M	$8.6K
Memphis Neurology PLLC	TN	Neurology Physician	$0	$3.9M

Scott Sullivan — Billing Profile & Reimbursement Data

Sign up for Scott Sullivan — Billing Profile & Reimbursement Data policy alerts

Scott Sullivan — Billing Profile & Reimbursement Data

Sign up for Scott Sullivan — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References